- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,922.80 / $14,468.70 / $25,314.80
| Facility | | $10,922.80 | $14,468.70 | $25,314.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,858.18 / $11,858.18 / $16,446.57
| Facility | | $11,858.18 | $11,858.18 | $16,446.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,843.91 / $12,318.78 / $25,183.76
| Facility | | $5,843.91 | $12,318.78 | $25,183.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,364.82 / $14,695.21 / $22,601.70
| Facility | | $10,364.82 | $14,695.21 | $22,601.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $14,910.73 / $22,774.29
| Facility | | $3,496.00 | $14,910.73 | $22,774.29 |